What are Medicare Part B Excess Charges?

What are Medicare Part B Excess Charges?

Written by:

|

Edited by:

|

|

In this article we’ll discuss:

What are Medicare Part B Excess Charges and will they affect me?

This is a question that may come up after you’ve been on Medicare for awhile.  Chances are this was not explained when you first enrolled in Medicare. Medicare Excess Charges are related to your Medicare Part B coverage for Medical Services.

What is Medicare Assignment?

Medicare Assignment refers to providers who WILL accept full payment by Medicare.  If a doctor does not accept Medicare Assignment, he or she IS allowed to bill you for Part B Excess Charges.

Providers can bill you for “excess charges” if they do not accept Medicare Assignment. The Part B Excess Charge is the amount above what Medicare approves for a procedure or office visit. Let’s say you visit the doctor and have a Medicare approved test done that cost $500.

The doctor performing the test does not accept Medicare Assignment and decides that $500 is not enough for the test. 

Because the doctor does not accept Medicare Assignment, he or she is able to charge an additional amount…this is the Part B Excess Charge.

The doctor, however, is limited to charging 15% over the Medicare approved amount.  So, Medicare will pay the doctor $500 and the doctor can bill you $75.

Accepting Medicare patients vs. Accepting Medicare Assignment

There are providers who see Medicare patients but do not accept Medicare Assignment.  If a doctor “accepts Medicare”, it doesn’t necessarily mean he or she accepts Medicare assignment and might charge you up to 15% more than the Medicare approved amount.

If you do not have a Medicare Supplement and use only Original Medicare Part A and B, you are still subjected to excess charges.  You pay the standard coinsurance of 20%, plus the excess charge up to 15%.

For example, you visit the doctor and the office visit is $100.  Your doctor accepts Medicare patients, but does not accept Medicare Assignment. You are billed the usual 20% coinsurance on the $100 visit ($20), plus the 15% excess charge that Medicare does not cover ($15).  Your final bill is $35.

Avoid Medicare Part B Excess Charges

Here are 3 important tips on avoiding excess charges:

1) Choose a Medigap Plan that pays for all Part B Excess Charges.

There are ten standardized Medigap Plans and only two will pay all Medicare Part B Excess Charges.  Presently, Medigap Plan F and Medigap Plan G will pay 100% of all excess charges.

2) Ask your doctor if he or she accepts Medicare Assignment.

If you currently have Medigap Plan A, B, C, D, K, L, M, or N, then you are responsible for paying any excess charges billed to you. Ask your doctor if he or she “accepts Medicare Assignment”.  If the answer is “yes”, and they absolutely accept Medicare Assignment, then you will not have to pay an excess charge.

3) Verify Medicare Assignment through Medicare.

Calling the doctor’s office to verify Medicare Assignment is helpful, but I also like the idea of double checking with Medicare.  This can be done by visiting Medicare.gov and searching the database for your doctor or specialist through the Find Doctors feature.

Once you locate their information, the database will tell you whether or not he or she accepts Medicare Assignment.

It’s a good idea to check Medicare Assignment before any doctor visit or procedure.

If, for example, you have to have surgery, ask who the anesthesiologist will be and verify their Medicare Assignment before the procedure.  It’s often the specialists we don’t think about that will bill you for excess charges.

Medicare Overcharge Measure

There are some states which have instituted the MOM Law (Medicare Overcharge Measure).  This means providers are not allowed to charge a patient any Part B excess charges. The states who fall under the MOM Law are:  Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont.

medicare part b excess charges

Are you paying Part B excess charges?  REMEDIGAP can help! We can research plans that will cover any excess charges. We can find the top insurers and locate the best coverage for your goals. Contact us today! We’ll provide you a free quote, answer any questions you have and find the top companies in your area. We’re here to help.

Additional Resources:

Medicare Plan N vs Plan G.

Confused about Medicare coverage?

Will I be Declined Medigap Coverage?

What are Medicare Part B Excess Charges

Find affordable Medicare Supplement plans

Questions?

We know that Medicare can be confusing.  We also know that everyone's situation is different. That's why we're here to help. Schedule your free consultation now!

About the author

Leave a Reply

Your email address will not be published. Required fields are marked *

Don't Overpay For A Medigap Plan!
Compare rates to find how much you may save!

Why You Can Trust REMEDIGAP

To ensure the highest level of quality and expertise, REMEDIGAP collaborates with a network of outside experts who contribute their valuable insights and knowledge. Maintaining the highest standards of accuracy and professionalism is paramount to us. That’s why our team of expert reviewers diligently examines our articles, providing invaluable insights and recommendations to ensure our content meets and exceeds these standards.

Our expert reviewers possess a wealth of knowledge and expertise in various domains, including health, personal finances, retirement planning, and insurance. Each member of our review team holds advanced degrees and certifications in their respective fields, solidifying their authority and credibility. With years of experience under their belts, they bring a depth of understanding and a discerning eye to the content evaluation process.

Our review process plays a pivotal role in guaranteeing that the information we provide is reliable, accurate, and up-to-date. By maintaining the highest standards, it ensures that our readers can trust the information they find on our website.

Author picture

Edited by

Paul Lane

Insurance Editor

Paul Lane has been a licensed insurance agent for over a decade. He is also a financial professional and holds a Series 6 securities license. He has experience editing insurance websites and blogs with a focus on auto, homeowners, renters, life insurance, disability and supplemental insurance products.

Don’t forget your FREE Guide to Medicare delivered straight to your email inbox!

Join our FREE 7-Day Medicare eCourse

Get our FREE Guide to 2023 Medicare Coverage delivered straight to your inbox.

REMEDIGAP Email course